Celiac disease treatment in MagnaCODE clinic, India

1. Celiac disease, Celiac disease Symptoms
A Symmissed cause of metabolic bone disease
INTRODUCTION
Celiac disease (CD) is a highly prevalent autoimmune disease. The symptoms of CD are varied and
atypical, with many patients having no gastrointestinal symptoms. Metabolic bone disease (MBD) is a
less recognized manifestation of CD associated with spectrum of musculoskeletal signs and symptoms,
viz. bone pains, proximal muscle weakness, osteopenia, osteoporosis, and fracture. We here report five
patients who presented with severe MBD as the only manifestation of CD.
MATERIALS AND METHODS
Records of 825 patients of CD diagnosed during 2002-2010 were retrospectively analyzed for clinical
features, risk factors, signs, biochemical, and radiological parameters.
RESULTS
We were able to identify five patients (0.6%) of CD who had monosymptomatic presentation with
musculoskeletal symptoms and signs in the form of bone pains, proximal myopathy, and fragility
fractures without any gastrointestinal manifestation. All the five patients had severe MBD in the form
of osteopenia, osteoporosis, and fragility fractures. Four of the five patients had additional risk factors
such as antiepileptic drugs, chronic alcohol consumption, malnutrition, and associated vitamin D
deficiency which might have contributed to the severity of MBD.
CONCLUSION
Severe metabolic disease as the only presentation of CD is rare. Patients show significant improvement
in clinical, biochemical, and radiological parameters with gluten-free diet, calcium, and vitamin D
supplementation. CD should be looked for routinely in patients presenting with unexplained MBD.
Rastogi A, Bhadada SK, Bhansali A, Kochhar R, Santosh R.
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